PALLIATIVE SURGERY IN MALIGNANT OBSTRUCTIVE-JAUNDICE - PROGNOSTIC INDICATORS OF EARLY MORTALITY

A prospective analysis of 50 patients undergoing palliative bypass sur gery for incurable malignant obstructive jaundice was carried out in a n attempt to identify factors predicting post-operative mortality. Fiv e clinical and nine laboratory parameters were studied. Fourteen patie nts died within 30 days of surgery. It was seen that levels of haemogl obin, hematocrit and serum albumin levels were significantly lower whi le serum bilirubin was significantly higher in patients who died compa red with the survivors. Patients having Hb <10 Gm/dL, serum bilirubin >350 mu mol/dL, serum albumin <2.5 g/dL and prothrombin index <60% exh ibited a higher percentage of mortality. On multivariate analysis, lev els of haemoglobin, serum albumin and serum bilirubin could be used to independently predict the outcome with an accuracy of 86%. This was v alidated by prospectively applying the regression equation derived fro m the first 30 patients to the next 20 patients. It was seen that the predicted outcome correlated with the actual outcome with a correlatio n coefficient of 0.5098 (P = 0.01), It is concluded that in patients w ith high bilirubin, low haemoglobin and low albumin levels palliative surgical procedures carry a high risk of post-operative mortality and non-surgical methods mag. be more suitable.